In Missouri, hopes dashed for Medicaid expansion under GOP proposal

If House Republicans pass their proposed replacement plan for the Affordable Care Act, state Medicaid programs would face some big changes, including a per-capita cap on spending.

Republicans introduced their plan Monday in the form of two budget reconciliation bills. Though the bills repeal several taxes that helped pay for the Affordable Care Act, they were sent into markup sessions before a cost estimate could be prepared by the Congressional Budget Office.

“The whole thing is moving very quickly, and not every component is transparent,” said Dave Dillon, spokesman for the Missouri Hospital Association. “By and large we think there is more possibility for harm than good when it comes to the hospital community.”

States like Illinois, which voted to take federal funds to expand Medicaid eligibility to those with incomes below 133 percent of the federal poverty line, would see a phase-out for many enrollees in the coming years. States like Missouri, which did not expand the program, would receive some relief from planned funding cuts to hospitals. Spending for state Medicaid programs would also be capped on a per-person basis by 2020, a move that Democrats and patient advocacy groups have sharply criticized.

After votes in the Missouri legislature to reject federal funding to expand Medicaid, about 96,000 of the state's residents made too much money to qualify for Medicaid, but too little to qualify for income-based subsidies to buy insurance on Healthcare.gov.

Republican leaders in Missouri’s statehouse remained confident in their votes.

“I think not expanding Medicaid was the correct decision for Missouri,” said Rep. David Wood, R-Versailles, who chairs the House subcommittee on Appropriations for Health, Mental Health and Social Services. “We have some issues that we need to straighten out and streamline and fix before we actually expand or make it larger.”

Further, Wood said that if Missouri had expanded Medicaid for the past four years, people who had received coverage through the expansion would now be facing the loss of their health insurance in the coming years.

“Having had given somebody healthcare for four years, even if they were to then lose it, is better than them not getting access to healthcare at all,” Lavender said. “We’re just getting the short end of the stick.”

In Missouri, Medicaid eligibility for adults with children remains at 19 percent of federal poverty. That's about $390 a month for a family of four. Eligibility for seniors, pregnant women and people with disabilities is substantially higher. Childless adults who do not fit into another category do not qualify for the program at all.

A previous measure in the Missouri statehouse to convert federal Medicaid funding to a block grant program, SB 28, did not advance in the Senate and has been laid over to the informal calendar.